title: Increased neutrophil-lymphocyte ratio is a poor prognostic factor in patients with primary operable and inoperable pancreatic cancer.
abstract: BACKGROUND
  The neutrophil-lymphocyte ratio (NLR) has been proposed as an indicator of systemic inflammatory response. Previous findings from small-scale studies revealed conflicting results about its independent prognostic significance with regard to different clinical end points in pancreatic cancer (PC) patients. Therefore, the aim of our study was the external validation of the prognostic significance of NLR in a large cohort of PC patients.
  
  
  METHODS
  Data from 371 consecutive PC patients, treated between 2004 and 2010 at a single centre, were evaluated retrospectively. The whole cohort was stratified into two groups according to the treatment modality. Group 1 comprised 261 patients with inoperable PC at diagnosis and group 2 comprised 110 patients with surgically resected PC. Cancer-specific survival (CSS) was assessed using the Kaplan-Meier method. To evaluate the independent prognostic significance of the NLR, the modified Glasgow prognostic score (mGPS) and the platelet-lymphocyte ratio univariate and multivariate Cox regression models were applied.
  
  
  RESULTS
  Multivariate analysis identified increased NLR as an independent prognostic factor for inoperable PC patients (hazard ratio (HR)=2.53, confidence interval (CI)=1.64-3.91, P<0.001) and surgically resected PC patients (HR=1.61, CI=1.02-2.53, P=0.039). In inoperable PC patients, the mGPS was associated with poor CSS only in univariate analysis (HR=1.44, CI=1.04-1.98).
  
  
  CONCLUSIONS
  Risk prediction for cancer-related end points using NLR does add independent prognostic information to other well-established prognostic factors in patients with PC, regardless of the undergoing therapeutic modality. Thus, the NLR should be considered for future individual risk assessment in patients with PC.
authors.affiliation: Division of Clinical Oncology, Department of Medicine, Medical University of Graz, Graz, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Stotz
authors.forename: A
authors.initials: A
authors.lastname: Gerger
authors.forename: F
authors.initials: F
authors.lastname: Eisner
authors.forename: J
authors.initials: J
authors.lastname: Szkandera
authors.forename: H
authors.initials: H
authors.lastname: Loibner
authors.forename: A L
authors.initials: AL
authors.lastname: Ress
authors.forename: P
authors.initials: P
authors.lastname: Kornprat
authors.forename: W
authors.initials: W
authors.lastname: AlZoughbi
authors.forename: W A
authors.initials: WA
authors.lastname: Zoughbi
authors.forename: F S
authors.initials: FS
authors.lastname: Seggewies
authors.forename: C
authors.initials: C
authors.lastname: Lackner
authors.forename: T
authors.initials: T
authors.lastname: Stojakovic
authors.forename: H
authors.initials: H
authors.lastname: Samonigg
authors.forename: G
authors.initials: G
authors.lastname: Hoefler
authors.forename: M
authors.initials: M
authors.lastname: Pichler
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008214:Lymphocytes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis